Speaker 1: Now, we will talk about preparedness. Preparedness means to be prepared for any expected disaster. It's a sort of risk control. You think about any disaster that might happen to you and your organization, and take all the precautions that help you face it and decrease damage as far as possible. In this video, we will speak about internal preparedness, which means disasters that might occur inside the hospital. And in another video, we will speak about external preparedness, which means disasters that might occur outside the hospital and affect our hospital. For more videos, visit my Facebook page, Health Care Quality. The hospital should be prepared to handle internal disasters in order to incur less structural damage and fewer or less severe employee injury. By internal disaster, we mean any event within the healthcare facility that presents danger to patients and personnel, warranting their evacuation to another internal location or to an external location for their safety. Examples include fire, explosion threat, internal toxic spill, hostage situation, loss of institutional utilities, and etc. ECI defined the internal disaster program to provide processes for determining the type, likelihood, and the consequences of hazards, threats, and events, determining the structural integrity of existing patient care environments and how they would perform in the event of a disaster, determining the hospital rule in such events, determining communication strategies for events, managing resources during events, including alternative sources, managing clinical activities during an event, including alternative care sites, identifying and assigning staff rules and responsibilities during the event, and managing emergencies when personal responsibilities of staff conflict with the hospital's responsibilities for providing patient care. The disaster preparedness program is tested by an annual test of the full program internally or as part of a community-wide test, for example, in coordination with the civil defense. Also, elements C through H of the program could be tested during the year. Emergency planning and training directly influence the outcome of an emergency situation. The main components of the plan. The emergency escape procedures and emergency escape route assignments. The escape route to be followed by each specific facility location. Many facilities develop formal evacuation plans that may include drawings or diagrams depicting evacuation routes as well as other site-specific information. Procedures for employees who remain on site after the alarm sounds. Sometimes, depending on the type of operation involved, certain employees will remain behind to shut down special equipment before they evacuate the building, to limit further damage to the equipment, or to reduce potential hazards, such as those from flowing liquids or gas under pressure. It's important to know that everyone got out. For example, safety wardens often check all offices and restrooms during an emergency evacuation. Emergency action plans should indicate which employees are responsible for rescue and medical duties, and the plan should define what those duties are. The plan should also determine the preferred means of reporting fires and other emergencies. It also should include the names of employees who can be contacted for further information or for an explanation of duties under the plan. Alarm systems. These are color-coded systems used to announce for the emergency situation through the overhead all over the hospital. An example of these systems is code blue for cardiac arrest, code yellow for external disaster, code red for fire, code pink for child abduction, code white for bomb threat, code strong for security help or fighting or abusing, code gray for radiation incident, and code brown for chemical spill. Evacuating the premises. This indicates the type of evacuation that employees are to use during an emergency. That might be evacuating the entire building into a safe area, or evacuating a specific area. Evacuation may be horizontal or vertical. Compartmentalization. Buildings are designed to prevent fire, heat, and smoke from spreading beyond the locations of origination. Building elements, such as firewalls, fire dampers, and fire doors, are designed to seal off one location from the next. This system is called compartmentalization. It increases the safety of evacuating building occupants because smoke and fire are not able to escape into exit busways. This drawing shows how fire and smoke compartments are designed. Maintainment of fire and smoke reduces property damage and prevents small fires from growing into large fires. In order for compartmentalization efforts to be effective, fire barriers must be maintained. Fire doors are designed to withstand fire, heat, and smoke for a period of from 20 minutes to 3 hours. Fire doors are required to be self-closing and have positive latching. Fire doors should never be wedge-opened. Maintaining fire barriers. Fire doors need occasional maintenance and repair to function properly and should be periodically checked. Sealing floor wall penetrations. All areas should be properly sealed to prevent the escape of fire, heat, and smoke. In penetrations, including holes in walls, around ducts, pipes, etc., these types of penetration should be sealed with appropriate fire-stopping material. Accountability. The fire service uses the term accountability to describe the process for pinpointing where personnel are located during emergency operations. An accountability system should be established to address the presence of employees and their location after evacuation. Considerations for sick time, vacations, and other absences from work need to be addressed. Other considerations include emergencies or drills conducted during shift changes and accounting for personnel who are not at an assignment work location when an alarm sounds or who move around a facility as part of their job. Emergency training and drills should be coordinated within the facility so that key staff are involved in the planning process and are aware of their responsibility in an emergency as well as during the drill. Times of training when the plan is developed. When the employee's responsibilities or designated actions under the plan change, employees who are assigned additional or increased responsibilities must review the plan at each change to see how the change affects their actions. For example, an employee who is promoted to shift supervisor needs to study the plan to determine additional responsibilities for the supervisor. Another indication that more drills are necessary would be a poor response by personnel during a scheduled drill or the actual activation of the fire alarm. Evacuation drills. They provide learning experiences for occupants and staff for a variety of emergency conditions. Previous experience in emergency situation may cause an employee to react faster than someone who has never had to evacuate a building under fire conditions. The fire drill. The goal of workplace fire drills is to familiarize employees with emergency procedures and the location of means of egress components provided within the facility. The fire drill is a tool that's used to ensure that occupants react properly in the event of an actual emergency within a facility. The primary objective of a fire drill is orderly evacuation, not speed. Certain personnel should be assigned from each department to assist in safely evacuating employees during an emergency. Such trained employees are often called safety wardens. A key responsibility of the emergency response team is to safely evacuate employees from the workplace. The breed drill assessment. Before conducting an evacuation drill in the workplace, the drill coordinator should conduct a breed drill assessment of the evacuation routes and assembly points. For example, the assessment might confirm that exits are clearly marked and that corridors are free of obstructions. The coordinator should also review the evacuation plan before a drill and identify any modifications necessary as a result of a change in staff operations or the facility. Emergency response may be provided by an outside organization, usually the public fire department, as well as, in some cases, an in-house fire response team. Maintaining a good working relationship with the public fire department and understanding what duties will be carried out by each of the two organizations are essential to an effective emergency action plan. After fire drills are completed, fire drill coordinators should conduct fire drill evaluations to evaluate occupant response, building fire protection systems, and so on. If the hospital experiences an actual disaster, activates its program, and debriefs properly afterwards, the situation represents the equivalent to an annual test. Assumed Rules The role an individual plays has an impact on his or her reaction in the event of an emergency. Individuals in leadership roles will regularly take charge. Employees may follow the lead of their supervisor or a long-term employee. Visitors in a facility will typically be more passive and look for guidance from other occupants or staff. Thank you. For more information, visit www.fema.gov